耳道皮瓣复合瓣开放式改良乳突根治术治疗外耳道胆脂瘤的疗效及对患者血清PON-1和LIVIN水平影响  

Efficacy of open modified radical mastoidectomy with ear canal skin flap and composite flap in the treatment of external auditory canal cholesteatoma and its effect on serum PON-1 and LIVIN levels

作　　者：段礼府[1] 鄢斌成 蒋宗玲 魏兴 胡一勇 DUAN Li-fu;YAN Bin-cheng;JIANG Zong-ling(Department of Otorhinolaryngology Head and Neck Surgery,Zigong First People's Hospital,Zigong Sichuan 643000,China)

机构地区：[1]自贡市第一人民医院耳鼻咽喉头颈外科,四川自贡643000

出　　处：《临床和实验医学杂志》2022年第10期1102-1106,共5页Journal of Clinical and Experimental Medicine

基　　金：四川省科技厅重点研发项目(编号:2019YFS0337);自贡市重点科技计划任务项目(编号:2019YLSF24)。

摘　　要：目的探讨耳道皮瓣复合瓣开放式改良乳突根治术治疗外耳道胆脂瘤的疗效及对患者血清对氧磷酶(PON)-1和LIVIN水平的影响。方法前瞻性选择2019年1月至2021年6月在自贡市第一人民医院诊治的Ⅲ型外耳道胆脂瘤患者60例作为研究对象,根据随机信封分配原则把患者分为复合瓣组与对照组,每组各30例。所有患者均给予全身麻醉,由同一组医师进行手术,对照组给予开放式改良乳突根治术治疗,复合瓣组给予耳道皮瓣复合瓣开放式改良乳突根治术治疗。观察两组患者的临床疗效,检测术前1 d与术后1个月判定气导听阈、气骨导差变化,记录两组术后1个月出现的并发症情况,检测术前1 d与术后1个月两组血清PON-1、LIVIN变化。结果术后1个月,复合瓣组的总有效率为100.00%,高于对照组(80.00%),差异有统计学意义(P<0.05)。复合瓣组术后1个月的头痛、耳内感染、听力下降等并发症发生率为6.67%,低于对照组(33.33%),差异有统计学意义(P<0.05)。术后1个月,两组的气导听阈与气骨导差均低于术前1 d,且复合瓣组气导听阈与气骨导差为(17.49±3.62)、(9.48±1.47)dBHL,均低于对照组[(22.20±3.21)、(14.10±1.31)dBHL],差异均有统计学意义(P<0.05)。两组术后1个月的血清PON-1和LIVIN含量低于术前1 d,复合瓣组血清PON-1和LIVIN含量为(5.69±0.14)、(2.76±0.16)pg/mL,均低于对照组[(11.09±1.47)、(5.20±0.37)pg/mL],差异均有统计学意义(P<0.05)。结论耳道皮瓣复合瓣开放式改良乳突根治术治疗外耳道胆脂瘤能抑制血清PON-1和LIVIN的释放,改善患者的听力,提高治疗效果,且可减少患者并发症的发生。Objective To investigate the efficacy of open modified radical mastoidectomy with ear canal flap and composite flap in the treatment of external auditory canal cholesteatoma and its effect on serum paraoxonase(PON)-1 and LIVIN levels.Methods A total of 60 cases of patients with typeⅢexternal auditory canal cholesteatoma diagnosed and treated in Zigong First People's Hospital from January 2019 to June 2021 were prospectively selected as the research subjects,and the patients were divided into the composite valve group and the control group with 30 cases in each groups accorded to the principle of random envelope allocation.All patients were given general anesthesia and operated by the same group of doctors.The control group were given open modified radical mastoidectomy,and the composite valve group were given open modified radical mastoidectomy with ear canal flap and composite flap.The clinical efficacy of the two groups of patients was observed.The air conduction hearing threshold and air-bone conduction difference were detected 1 day before operation and 1 month after operation.Complications occurred in the two groups at 1 month after operation were recorded.The changes of serum PON-1 and LIVIN in the two groups were detected 1 day before operation and 1 month after operation.Results At 1 month after operation,the total effective rate of composite valve group was 100.00%,which was higher than that of control group(80.00%),the difference was statistically significant(P<0.05).The incidence rate of complications such as headache,ear infection and hearing loss in the composite valve group at 1 month after operation was 6.67%,which was lower than that in the control group(33.33%),the difference was statistically significant(P<0.05).At 1 month after operation,the air conduction hearing threshold and air-bone conduction difference in both groups were lower than those at 1 day before operation,and the air conduction hearing threshold and air-bone conduction difference in the composite valve group were(17.49±3.62)dB

关 键 词：耳道皮瓣复合瓣 开放式改良乳突根治术 外耳道胆脂瘤 对氧磷酶-1 LIVIN 

分 类 号：R764.91[医药卫生—耳鼻咽喉科]